Title Page

  • RA Title

  • Type of RA

  • Location of the Workplace

  • Site

  • Prepared on

  • Assessor

  • Existing RA reference

  • External RA reference

  • Reference guidance

Scope of the Workplace Risk Assessment

  • What's included in this workplace risk assessment?

  • What's not included in this workplace risk assessment?

Workplace Risk Assessment

    Hazard
  • Hazard Type

  • Risk related to hazard

  • Who might be harmed

  • PPE

  • Training

  • Can the hazard causing risk be eliminated?

  • Are you already doing something to control this risk (existing risk control measure)?

  • Develop a risk control measure targeting this risk.

  • Briefly describe the existing control measure:

  • Further action needed to control the risk?

  • Select the "Action" icon to create an action, assign it to someone, and set a due date.

  • Seek further advice from safety department or wider industry.

  • Eliminate the hazard causing the risk.

  • Residual Risk likelihood

  • Residual Risk consequence

  • Use this risk matrix to identify the risk level:

    Risk Matrix SafetyCulture.png
  • Residual Risk level

Completion/Review

  • How often will the RA be reviewed?

  • Date for next review

  • Has the RA content been updated since last signing?

  • Send out actions for all RA users to sign updated version

  • RA Assessor name

  • Role/position

  • Training type

  • Additional training type/details

  • RA Accepted

  • Signature

  • Add another person

  • Name

  • Role

  • Training type

  • Additional training type/details

  • RA Accepted

  • Signature

  • Add another person

  • Name

  • Role

  • Training type

  • Additional training type/details

  • RA Accepted

  • Signature

  • Add another person

  • Name

  • Role

  • Training type

  • Additional training type/details

  • RA Accepted

  • Signature

  • Add another person

  • Name

  • Role

  • Training type

  • Additional training type/details

  • RA Accepted

  • Signature

  • Add another person

  • Name

  • Role

  • Training type

  • Additional training type/details

  • RA Accepted

  • Signature

  • Add another person

  • Name

  • Role

  • Training type

  • Additional training type/details

  • RA Accepted

  • Signature

  • Add another person

  • Name

  • Role

  • Training type

  • Additional training type/details

  • RA Accepted

  • Signature

  • Add another person

  • Name

  • Role

  • Training type

  • Additional training type/details

  • RA Accepted

  • Signature

  • Add another person

  • Name

  • Role

  • Training type

  • Additional training type/details

  • RA Accepted

  • Signature

  • Add another person

  • Name

  • Role

  • Training type

  • Additional training type/details

  • RA Accepted

  • Signature

  • Add another person

  • Name

  • Role

  • Training type

  • Additional training type/details

  • RA Accepted

  • Signature

  • Add another person

  • Name

  • Role

  • Training type

  • Additional training type/details

  • RA Accepted

  • Signature

  • Add another person

  • Name

  • Role

  • Training type

  • Additional training type/details

  • RA Accepted

  • Signature

  • Add another person

  • Name

  • Role

  • Training type

  • Additional training type/details

  • RA Accepted

  • Signature

  • Add another person

  • Name

  • Role

  • Training type

  • Additional training type/details

  • RA Accepted

  • Signature

The templates available in our Public Library have been created by our customers and employees to help get you started using SafetyCulture's solutions. The templates are intended to be used as hypothetical examples only and should not be used as a substitute for professional advice. You should seek your own professional advice to determine if the use of a template is permissible in your workplace or jurisdiction. You should independently determine whether the template is suitable for your circumstances.